Fetal Pulmonary Veins Research Articles

Slow flow HD and traditional CDFI technologies in identifying pulmonary veins in the first trimester.

This study aims to assess the feasibility and effectiveness of color doppler flow imaging (CDFI) technology and the Slow Flow HD imaging technique in identifying fetal pulmonary veins (PVs) in the first trimester (11-13 + 6weeks), and further explore the factors affecting fetal pulmonary vein identification in early pregnancy. Echocardiography and scanning of PVs were performed in 240 normal singleton fetuses in early pregnancy by using CDFI and slow flow HD techniques, to compare the ability of two methods to identify the PVs. Slow Flow HD technology was used to further investigate the difference of PVs identification at different gestational ages [group I (11-11 + 6weeks), group II (12-12 + 6weeks), group III (13-13 + 6weeks)] and with different maternal body mass indices (BMI) (≥ 25 and < 25). In 31 cases of 240 fetuses, transvaginal ultrasonography was added due to maternal habitus or significant retroversion of the uterus, and the difference in PVs identification between transabdominal and transvaginal examination was analyzed. Successful PVs identification rates via CDFI and Slow Flow HD were 32.0% and 88.3%, respectively (p < 0.05). The identification rate of at least one and two pulmonary veins in Slow Flow HD was 88.3% and 76.2%, and all four pulmonary veins in 11.6% (p < 0.05). The identification rate of group I, II and III were 76.4%, 88.9% and 96.0%, respectively. The identification rate was 45.1% in the transabdominal ultrasound group and 83.8% in the transvaginal ultrasound group. The identification rate was 62.5% in the BMI ≥ 25 group and 94.7% in the BMI < 25 group (p < 0.05). Slow Flow HD can detect PVs in early pregnancy more often than using CDFI. Slow Flow HD is a feasible and effective imaging technique for evaluating PVs in early pregnancy.

Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester.

This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging (CDFI) technology and the high-definition flow imaging (HDFI) technique in detecting fetal pulmonary veins (PVs) in the first trimester (11-13+6 weeks). From December 2018 to October 2019, 328 pregnant women with 328 normal singleton fetuses (crown-rump length: 45-84 mm) who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study. The cases were divided into three groups according to the gestational age: group A, 11+0 -11+6 weeks; group B, 12+0 -12+6 weeks; and group C, 13+0 -13+6 weeks. Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly. The abilities of CDFI and HDFI to display PVs were compared. Successful PV display rates via CDFI and HDFI were 2.3% and 68.2% (P<0.01), 22.4% and 82.4% (P<0.01), 41.5% and 91.2% (P<0.01) for group A, group B, and group C, respectively. The total successful display rates for the two methods were 28.9% (CDFI) and 84.8% (HDFI) (P<0.01). The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy (11-13+6 weeks). HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.

Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control.

This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

VP49.04: Feasibility study of transabdominal real‐time CDFI and HDFI techniques for fetal pulmonary vein display in the first trimester (11–13+6 weeks)

VP49.04: Feasibility study of transabdominal real‐time CDFI and HDFI techniques for fetal pulmonary vein display in the first trimester (11–13⁺⁶ weeks)

REFERENCE RANGES FOR DOPPLER-ASSESSED FETAL PULMONARY VENOUS BLOOD FLOW VELOCITIES AND PULSATILITY INDICES IN NORMAL GROWTH FETUSES

Background: The aim of this study was to establish reference range with gestation for Doppler parameters in the fetal pulmonary venous blood of normal fetal growth, and indices reflecting left atrial pressure changes. Materials and Methods: Cross-sectional data were collected from 168 normal fetal growth between 28 and 40 weeks of gestation. Investigations of fetal pulmonary veins was performed by Doppler echocardiography to measure parameters: peak systolic velocity (S), peak diastolic velocity (D), end-diastolic velocity (A), and to calculate : peak velocity index for veins (PVIV), pulsatility index for viens (PIV). Regression analysis was used to detemine reference ranges with gestation. Results: Mean maternal age of study population was 29.79 ± 5.47 years old, and mean gestational age was 35.55 ± 2.73 weeks, average birth weight of fetus was 2547 ± 647 gr. A significant increase was observed in S, D, A with advancing gestation. Meanwhile, PVIV and PIV was decreasing significantly by advancing the gestational age. Conclusion: A reference range with gestation for Doppler parameters of fetal pulmonary venous blood of normal fetal growth has been established In the case of a normally growing fetus with a gestational age of 28 to 40 weeks, fetal pulmonary venous Doppler parameters are strongly correlated with gestational age. The flow velocity of the S, D, and A waves increases with gestational age. Peak velocity index (PVIV) and pulse index (PI) decrease with gestational age.

Neonatal Outcomes in Total Anomalous Pulmonary Venous Return: The Role of Prenatal Diagnosis and Pulmonary Venous Obstruction.

The objective of this study is to evaluate neonatal outcomes of total anomalous pulmonary venous return (TAPVR) and identify fetal echocardiography findings associated with preoperative pulmonary venous obstruction (PPVO). This retrospective study evaluated TAPVR cases from 2005 to 2014 for preoperative and postoperative outcomes based on prenatal diagnosis, PPVO, and heterotaxy syndrome. Fetal pulmonary and vertical vein Dopplers were analyzed as predictors of PPVO. Of 137 TAPVR cases, 12% were prenatally diagnosed; 60% had PPVO, and 21% had heterotaxy. Of the prenatally diagnosed patients, 63% also had heterotaxy. TAPVR repair was performed in 135 cases and survival to discharge was 82% (112/137). Heterotaxy was the only independent predictor of mortality on multiple regression analysis [OR 5.5 (CI 1.3-16.7), p = 0.02]. PPVO was associated with preoperative acidosis, need for inhaled nitric oxide, and more emergent surgery, but not postoperative mortality. Fetal vertical vein Doppler peak velocity > 0.74m/s mmHg predicted PPVO (93% sensitivity; 83% specificity) while pulmonary vein Doppler did not. TAPVR has severe neonatal morbidity and mortality with low prenatal diagnosis rates in the absence of heterotaxy. Patients with obstructed TAPVR had greater preoperative morbidity, but only heterotaxy was independently associated with increased postoperative mortality. Vertical vein velocity helped prenatally identify those at risk of PPVO.

Role of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation in detecting fetal pulmonary veins.

Prenatal diagnosis of fetal total anomalous pulmonary vein connection (TAPVC) remains challenging for most screening sonographers. The purpose of this study was to evaluate the use of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation (4D-HDFI) in identifying pulmonary veins in normal and TAPVC fetuses. We retrospectively reviewed and performed 4D-HDFI in 204 normal and 12 fetuses with confirmed diagnosis of TAPVC. Cardiac volumes were available for postanalysis to obtain 4D-rendered images of the pulmonary veins. For the normal fetuses, two other traditional modalities including color Doppler and HDFI were used to detect the number of pulmonary veins and comparisons were made between each of these traditional methods and 4D-HDFI. For conventional echocardiography, HDFI modality was superior to color Doppler in detecting more pulmonary veins in normal fetuses throughout the gestational period. 4D-HDFI was the best method during the second trimester of pregnancy in identifying normal fetal pulmonary veins. 4D-HDFI images vividly depicted the figure, course, and drainage of pulmonary veins in both normal and TAPVC fetuses. HDFI and the advanced 4D-HDFI technique could facilitate identification of the anatomical features of pulmonary veins in both normal and TAPVC fetuses; 4D-HDFI therefore provides additional and more precise information than conventional echocardiography techniques.

Fetal pulmonary venous blood flow velocities in a normal population and new calculated reference values.

The aim of this study is to establish new Doppler reference values in a population with normal pulmonary veins during different phases of the fetal cardiac cycle for maximum blood flow velocities during ventricular systole (S), early ventricular diastole (D), atrial contraction (a), intensity-weighted mean velocity (Vmean) and the indices derived from these parameters [(S - a)/D] and [(S - a)/Vmean]. The pulsed-wave color advanced dynamic flow Doppler technique was used in a prospective cross-sectional study of 365 low-risk pregnancies between 18 and 41 completed gestational weeks. Reference ranges were calculated for the individual measuring parameters based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square principle. During the observation period of 18 to 41 gestational weeks, a continuous increase was evident in maximum flow velocities for ventricular systole (S), early ventricular diastole (D), atrial contraction (a) and intensity-weighted mean velocity (Vmean) of 14.7 to 431.1, 12.5 to 426.2, 5.4 to 411.9 and 8.7 to 421.6 cm/s, respectively. Venous indices, however, showed a decrease with increasing gestational age: (S - a)/D from 0.9 to 0.7 and (S - a)/Vmean from 1 to 0.9. The newly established normal values for the fetal pulmonary vein can be used in standardized Doppler sonography measurement to assess the left atrial pressure in the fetal heart. © 2016 John Wiley & Sons, Ltd.

Autopsy findings of 19 cases of pulmonary vein abnormalities associated with fetal cardiac anomalies

To improve the diagnostic accuracy of fetal pulmonary venous abnormalities through the analysis of the fetal pulmonary vein anatomy. 234 cases of congenital cardiac abnormalities were detected by echocardiography during pregnancy in An Zhen Hospital, Capital Medical University from May 2010 to August 2015. Autopsy was then performed. The type of fetal pulmonary venous malformation, cardiac abnormalities, systemic venous malformations, and other internal organs deformities were documented. There were ninteen cases of pulmonary venous malformations among the 234 cases of fetal congenital heart disease. These included two cases of congenital pulmonary venous hypoplasia (CPVH) or atresia, four cases of partial anomalous pulmonary venous drainage (PAPVD), seven cases of total anomalous pulmonary venous drainage (TAPVD), five cases of atresia of common pulmonary vein (CPV), one case of congenital pulmonary venous hypoplasia with total anomalous pulmonary venous drainage. There were eleven cases with single ventricle, eight cases with right aortic arch, seven cases with single atrium and six cases with pulmonary valve stenosis. Eleven cases had pulmonary hypoplasia and nine cases had abnormal spleen. There are many variations in pulmonary venous abnormalities associated with severe and complex cardiac abnormalities and internal organs malformation. Care should be exercised during autopsy examination to look for all branches of the pulmonary vein.

Evaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study

AbstractCongenital heart disease (CHD) is the leading cause of infant mortality. Nevertheless, routine prenatal ultrasound only detects 30 %–50 % of CHD cases. Therefore, emphasis should be placed on early predictors of CHD that allow physicians to timely refer high-risk patient to specialized fetal echocardiography, in order to maximize chances of improved outcomes. The fetal venous system has been the focus of attention as a marker of heart function. Yet, there exist inconsistent data about the acquisition of pulmonary venous flow in early pregnancy. This study aims to determine the feasibility of fetal pulmonary venous flow acquisition in early pregnancy, and the association between pulmonary vein (A-wave) flow reversal and the presence of CHD. Total of 211 consecutive pregnant women, between 12 and 15 weeks of gestation, underwent routine obstetric ultrasound along with basic fetal echocardiography including fetal pulmonary venous flow assessment. The pulmonary venous flow velocity waveforms were acquired by either Doppler or Doppler plus enhance flow technique based on equipment availability. All the cases were re-evaluated by specialized fetal echocardiography during late pregnancy to identify congenital heart anomalies. The acquisition of fetal pulmonary vein, between 12 and 15 weeks of gestation, was successfully accomplished in 87.7 % of cases. Five out of seven fetuses with end-diastolic (A-wave) pulmonary venous flow reversal were associated with confirmed cardiac anomaly. In this pilot study, pulmonary venous (A-wave) flow reversal was associated with cardiac anomalies in 86.8 % of cases (p = 0.001). This pilot study proposes that Doppler interrogation of fetal pulmonary vein flow during early pregnancy is feasible. Furthermore, the presence of pulmonary vein (A-wave) reversal might represent a marker of major cardiac anomalies. Further investigation is needed to confirm these findings.

Topographic anatomy of the fetal inferior vena cava, coronary sinus, and pulmonary veins: Variations in Chiari's network.

To understand anomalies in Chiari's network better, we assessed the topographical anatomy of the fetal inferior vena cava (IVC), coronary sinus, and atria. We examined sagittal serial paraffin sections of 15 human fetuses of crown-rump length 24-36 mm, corresponding to a gestational age of 8 weeks. Although their outflow tract morphologies were similar, these 15 specimens could be classified into two groups. In eight specimens, the left common cardinal vein reached the body wall, whereas in the other seven the vein was obliterated near the left pulmonary vein. Irrespective of the group in which the specimen was included, the anteroposterior arrangement of the coronary sinus, the sinus septum (septum), and the right sinus valve (right valve) could be classified into three types: the right valve-septum-coronary sinus arrangement in seven specimens; the right valve-coronary sinus-septum arrangement in five; and the coronary sinus-right valve-septum arrangement in three. Depending on differences in topographical anatomy, the sinus septum separated the coronary sinus opening from either the right or the left atrium. Likewise, the coronary sinus opening was either adjacent to or distant from the IVC terminal. Rather than the counter-side position of the right valve being at the IVC terminal, the left sinus valve protruded leftward, forming an incomplete interatrial septum. Fetal variations seemed to be closely connected with individual variations and a high frequency of Chiari's network anomalies in adults.

Platelet-activating factor synthesis and receptor-mediated signaling are downregulated in ovine newborn lungs: relevance in postnatal pulmonary adaptation and persistent pulmonary hypertension of the newborn.

Platelet-activating factor (PAF) is a phospholipid with a wide range of biological activities. We studied PAF metabolism and PAF receptor (PAFR) signaling in perinatal ovine lungs to understand PAF's role in transition of the perinatal pulmonary hemodynamics and pathophysiology of persistent pulmonary hypertension of the newborn. We hypothesized that downregulation of PAF synthesis with upregulation of PAF catabolism by acetylhydrolase (PAF-Ah) in the newborn lung is needed for fetus-to-newborn pulmonary adaptation. Studies were conducted on fetal and newborn lamb pulmonary arteries (PA), veins (PV) and smooth muscle cells (SMC). PAF metabolism, PAFR binding and cell proliferation were studied by cell culture; gene expression was studied by qPCR. Fetal lungs synthesized 60% more PAF than newborn lungs. Compared with the fetal PVs and SMCs, PAF-Ah activity in newborn was 40-60% greater. PAF-Ah mRNA expression in newborn vessels was different from the expression by fetal PA. PAF-Ah gene clone activity confirmed deletion of hypoxia-sensitive site. PAFR mRNA expression by the PVs and SMC-PV of the fetus and newborn was greater than by corresponding PAs and SMC-PA. Q-PCR study of PAFR expression by the SMC-PV of both groups was greater than SMC-PA. Fetal SMCs bound more PAF than the newborn SMCs. PAFR antagonist, CV-3988, inhibited PAFR binding and DNA synthesis by the fetal SMCs, but augmented binding and DNA synthesis by newborn cells. We show different PAF-PAFR mediated effects in perinatal lungs, suggesting both transcriptional and translational regulation of PAF-Ah and PAFR expression in the perinatal lamb lungs. These indicate that the downregulation of PAF-mediated effects postnatally protects against persistent pulmonary hypertension of the newborn.

Evaluation of normal fetal pulmonary veins using B‐flow imaging with spatiotemporal image correlation and by traditional color Doppler echocardiography

The purpose of our report is to evaluate the use of color Doppler echocardiography (CDE) with four chamber view (4CV), scanning around left atrium, and four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation (4D BF-STIC) in detecting fetal pulmonary veins at 17 to 40 weeks' gestation. This was a prospective study. Color Doppler echocardiography with 4CV, scanning around left atrium, and 4D BF-STIC were used to detect the pulmonary veins in 460 normal fetuses at 17 to 40 weeks of gestation. Routine prenatal screening was used to confirm that the fetuses were in good health with no cardiac or extra cardiac anomalies. All patients underwent follow up at one year. Twenty-two patients were excluded from the study. The number of pulmonary veins visualized using each method was recorded and then compared in six subgroups according to gestational age. Four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation was the best method to detect the greatest number of pulmonary veins between 17 and 31 weeks of gestation. Scanning around left atrium detected more pulmonary veins than the traditional 4CV method throughout the gestational period. The scanning around left atrium method proved to be the most suited for detecting pulmonary veins in clinical practice. 4D BF-STIC was superior in detecting the greatest number of pulmonary veins before 32 gestational weeks, but had limited clinical usage because it was very time-consuming and experience-dependent. The 4D method should be considered as a complement to traditional two-dimensional sonography, because it facilitates understanding of the anatomy and the spatial relationships of the cardiac structures.

Ultrasound vascular enhancement technology in the detection of fetal pulmonary vein

Objective To investigate the ultrasound vascular enhancement technology(VET)in the ultrasound detection of fetal pulmonary vein.Methods According to gestational age,289 cases of fetal pulmonary vein were divided into group A(15 to 22 weeks,n =89),group B(23 to 30 weeks,n =152),group C(31 to 38 weeks,n =48).In these groups,VET technology,two-dimensional echocardiography (2DE),color Doppler flow imaging(CDFI),color Doppler energy(CDE)were simultaneously detected.VET technology Results were compared with the other three methods,and compared in different gestational age groups.Results Four fetal pulmonary veins in different groups of gestational week were displayed as following:In group A,2DE showed 11 cases(12.36％),CDFI 38 cases(42.70％),CDE 42 cases (47.19％),VET 70 cases(78.65％),compared with 2DE,CDFI and CDE,the positive rate of VET was significantly higher(P＜0.05).In group B,2DE showed 36 cases(23.68％),CDFI 75 cases(49.34％),CDE 82 cases(53.95 ％),VET 145 cases 95.39(％),compared with 2DE,CDFI and CDE,the positive rate of VET was significantly higher(P＜0.05).In group C,2DE showed 16 cases(33.33％),CDFI 30 cases (62.50 ％),CDE 32 cases(66.67 ％),VET 29 cases(60.42 ％),compared with 2DE,the positive rate of VET was significantly higher(P＜0.05);compared with CDFI and CDE,the positive rate of VET was no significant difference(P＞0.05).The display rate of four fetal pulmonary veins in group B was the highest,and the positive display rate in group A was significantly higher than in group C(P＜0.05).Conclusions VET can significantly improve the display rate of the fetal pulmonary vein,and locate inspection of fetal pulmonary vein.The best time for fetal pulmonary vein to check is the second trimester. Key words: Ultrasonography,prenatal; Fetus; Pulmonary veins; Vascular enhancement technology

Evaluation of normal fetal pulmonary veins from the early second trimester by enhanced‐flow (e‐flow) echocardiography

To explore the feasibility of using enhanced-flow (e-flow) imaging technology to identify fetal pulmonary veins and establish gestational age-specific reference values at 12-40 weeks' gestation. The pulmonary venous internal diameter, peak systolic and diastolic flow velocities and visualization rate were analyzed in 332 normal fetuses at 12-40 weeks of gestation. Two-dimensional gray-scale (2D) ultrasound, color Doppler and e-flow imaging were used to detect the pulmonary veins in the four-chamber view by taking the lung as the penetration window. The pulmonary veins could be visualized as early as 12 weeks' gestational age by e-flow imaging. The right and left pulmonary venous internal diameters and peak systolic and diastolic flow velocities increased with increasing gestational age. Between 12 and 40 gestational weeks, the internal diameter and both the systolic and diastolic flow velocities of the fetal right pulmonary vein were significantly larger than were those of the left vein (P < 0.05). Of 118 fetuses at 12-22 gestational weeks, the visualization rate of the four pulmonary veins (left superior and inferior, right superior and inferior) was 5.9% (7/118) by 2D ultrasound, 41.5% (49/118) by color Doppler and 61.9% (73/118) by e-flow imaging. The visualization rate by e-flow imaging was significantly higher than that using the other two techniques (P < 0.001). e-flow imaging is apparently a feasible and promising technology with which to identify the fetal pulmonary veins in the early stages of the second trimester.

Application of E-flow in ultrasound examination of fetal pulmonary vein

Objective To explore the value of E-flow technique in ultrasound examination of fetal pulmonary vein.Methods The pulmonary veins of 332 fetus were examined using lungs as acoustic window by two-dimensional echocardiography(2DE), color Doppler flow imaging (CDFI) and E-flow.Visualization ratios of the three methods were compared.Results The fetal pulmonary veins were displayed as following:7 cases were showed by 2DE,49 cases by CDFI and 73 cases by E-flow among 118 cases during 12 - 22 gestational weeks.The visualization ratio of E-flow was higher than that of the other two methods (P ＜0.001).Fourty-one cases were showed by 2DE, 171 cases by CDFI and 177 cases by E-flow among 214 cases during 23 - 40 gestational weeks.The visualization ratios of E-flow and CDFI were higher than that of 2DE (P ＜ 0.001).The visualization ratio of E-flow and CDFI has no distinct differrence (P ＞ 0.0167).Conclusions E-flow was sensitive to pulmonary vein blood flow and better than 2DE and CDFI in early stage of the second trimester. Key words: Ultrasonography, prenatal; Fetus; Pulmonary veins

OP15.07: The role of enhance flow imaging in visualizing and locating in fetal pulmonary veins

OP15.07: The role of enhance flow imaging in visualizing and locating in fetal pulmonary veins

OP15.09: Comparison of real‐time three‐dimensional echocardiography and spatio‐temporal image correlation in assessment of fetal interventricular septum

pulmonary vein was further to interatrial septum from the 4-chamber view, connected with left atrium obliquely. The left inferior pulmonary vein was close to descending aorta from 4-chamber view, connected with left atrium vertically. The left inferior pulmonary vein was located to anterior descending aorta from aortic arch view, and formed 90◦ angel with descending aorta. The right superior pulmonary vein was close to apical right atrium and superior vena cava from 4-chamber view, connected with left atrium. The right inferior pulmonary vein was near to spine, parallelled to interatrial septum, connected with left atrium. Conclusions: There is an advantage in visualizing and locating in fetal pulmonary veins by EFI combine with 2 dimensional echocardiography. Pulmonary veins anatomy should be checked during fetal heart examination.

360 Fetal pulmonary vein doppler flow pattern: Predicting the need for immediate left atrial decompression in hypoplastic left heart syndrome with restrictive atrial septum

BACKGROUND: Fetal pulmonary venous (PV) Doppler flow has been correlated with the severity of atrial septal restriction (ASR) and the need for emergent atrial septostomy (EAS) in newborns with HLHS. According to Michelfelder et al (JTCS 2011), a fetal forward/reverse PV Doppler flow velocity-time integral (PV VTI) ratio 5 predicted the need for EAS, required in 21% of their 39 HLHS cases, with a sensitivity of 100% and a specificity of 94%. We reviewed our contemporary institutional experience with this entity. METHODS: Echocardiograms and outcomes of 67 consecutive fetal HLHS cases with active postnatal management were reviewed. PV Doppler assessments included maximal S-, Dand A-wave flow velocities (cm/s); A-wave duration (ms), S/D wave and forward/reverse PV VTI ratios. EAS 1 days of age and survival to infancy were used as clinical outcome variables. RESULTS: Four (6%) of the 67 cases required an EAS for an intact (n 1) or severely restrictive atrial septum. The table indicates the median (range) fetal PV Doppler indices at the pre-delivery echocardiogram of newborns with/without EAS:

Preservation of cGMP-induced relaxation of pulmonary veins of fetal lambs exposed to chronic high altitude hypoxia: role of PKG and Rho kinase

The roles of Rho kinase (ROCK) and cGMP-dependent protein kinase (PKG) in cGMP-mediated relaxation of fetal pulmonary veins exposed to chronic hypoxia (CH) were investigated. Fourth generation pulmonary veins were dissected from near-term fetuses ( approximately 140 days of gestation) delivered from ewes exposed to chronic high altitude hypoxia for approximately 110 days (CH) and from control ewes. After constriction with endothelin-1, 8-bromoguanosine 3',5'-cyclic monophosphate (8-Br-cGMP) caused a similar relaxation of both control and CH vessels. Rp-8-Br-PET-cGMPS (a PKG inhibitor) inhibited whereas Y-27632 (a ROCK inhibitor) augmented relaxation of control veins to 8-Br-cGMP. These effects were significantly diminished in CH veins. PKG protein expression and activity were greater whereas ROCK protein expression and activity were less in CH vessels compared with controls. Phosphorylation of threonine 696 (ROCK substrate) and serine 695 (PKG substrate) of the regulatory myosin phosphatase targeting subunit MYPT1 of myosin light chain (MLC) phosphatase was stimulated to a lesser extent in CH than in control veins by endothelin-1 (ROCK stimulant) and 8-Br-cGMP (PKG stimulant), respectively. The phosphorylation and dephosphorylation of MLC caused by endothelin-1 and 8-Br-cGMP, respectively, were less in CH veins than in controls. These results suggest that CH in utero upregulates PKG activity but attenuates PKG action in fetal pulmonary veins. These effects are offset by the diminished ROCK action on MYPT1 and MLC and thus lead to an unaltered response to cGMP.